Articles Posted in Insurance Law

The Supreme Court reversed the decision of the Court of Appeals affirming the decision of the district court granting summary judgment to The Bar Plan Mutual Insurance Company on Daniel Becker’s insurance coverage dispute with the company, holding that the lower courts erroneously relied upon certain caselaw in granting summary judgment and that, under the correct caselaw, questions of fact remained that were inappropriate for summary judgment.
Specifically, the Court held (1) the lower courts erred in relying on the “expansion of coverage” rule in concluding that Becker was asking for the coverage to be expanded beyond the insurance contract’s terms and that that courts should instead have continued their analysis to see if estoppel was appropriate to apply to the facts under the “reservation of rights” rule; and (2) because several genuine issues of material fact remained on the issue of estoppel, this case must be remanded for further proceedings. View "Becker v. Bar Plan Mutual Insurance Co." on Justia Law

The Supreme Court affirmed the decision of the court of appeals affirming the judgment of the district court ordering Devin Wilson to pay Kenneth Risley a jury award in favor of Risley, holding that the district court did not err in determining that the assignment provision in Kan. Stat. Ann. 40-3113a(c) did not divest Risley of the right to recover his medical expenses from the tortfeasor.
A jury found Wilson liable in tort for injuring Risley in an automobile accident and awarded Risley the cost of his medical expenses in addition to other compensation. Risley had previously been paid for his medical expenses under the personal injury protection (PIP) coverage of his automobile insurance policy. The jury entered judgment on the entire amount of damages as awarded by the jury. On appeal, Wilson argued that Risley had no right to sue for the medical expenses because the cause of action for those medical expenses had been statutorily assigned pursuant to section 40-3113a(c) to Risley’s PIP insurance carrier. The court of appeals affirmed. The Supreme Court affirmed, holding that Risley was entitled to the full damages as awarded by the jury, including any medical expenses that were duplicative of the PIP benefits Risley received from his PIP insurance carrier. View "McCullough v. Wilson" on Justia Law

Tenth-grader Jesus Rodriguez was injured while traveling to a soccer match in the bed of a pickup truck driven by a fellow student and teammate. Mutual of Omaha Insurance Company had issued a policy to the Kansas State High School Activities Association, which administered various extracurricular activities in the state. Rodriguez’s mother (Plaintiff) filed a claim with Mutual of Omaha. Mutual of Omaha denied the claim, reasoning that the travel during which Rodriguez was injured did not qualify as covered under the policy. Plaintiff sued the school district, Mutual of Omaha, and other defendants. The district judge held that Mutual of Omaha should be dismissed as a defendant in the case because Rodriguez’s travel was neither authorized by the school district nor subject to reimbursement, the two requirements for “covered travel” under the definition in the Mutual of Omaha policy. The court of appeals affirmed, holding that the travel involved in this case did not qualify as subject to reimbursement, and thus there was no coverage under the policy. The Supreme Court reversed, holding that the travel during which Rodriguez was injured was “authorized” and “subject to reimbursement,” and therefore, there was coverage under the policy language. View "Rodriguez v. United Sch. Dist. No. 500" on Justia Law

Plaintiff was injured from an automobile accident. A hospital toxicology report indicated that Plaintiff had a blood alcohol concentration of .25 two hours after the accident. Plaintiff submitted a claim to American Family Life Assurance Company of Columbus (AFLAC) pursuant to his hospital intensive care policy. AFLAC denied the claim under the policy’s intoxication exclusion, relying in part on the hospital toxicology report. Plaintiff filed suit seeking coverage under the policy. AFLAC moved to admit a copy of the toxicology report. Plaintiff objected, citing a lack of foundation. The district court sustained Plaintiff’s objection. After a trial, the district court concluded that Plaintiff was entitled to coverage under the policy because AFLAC failed to prove that Plaintiff’s accident was in consequence of his intoxication. The court of appeals reversed. The Supreme Court reversed the court of appeals and affirmed in part and reversed in part the district court, holding (1) the court of appeals erred in determining that AFLAC had satisfied the appropriate foundation requirements to admit the hospital’s toxicology report; (2) AFLAC failed to meet its burden of establishing that Plaintiff’s claim was excluded under the policy; and (3) the district court erred in determining that AFLAC’s denial of coverage was without just cause or excuse. View "Wiles v. Am. Family Life Assurance Co." on Justia Law

Dick McClary submitted an application for health insurance to Golden Rule Insurance Company that failed to disclose proposed insured Patti Denney’s preexisting condition. Golden Rule issued a policy covering Denney, but later denied coverage for a proposed surgery based on the fact that the conditions documented in Denney’s medical records were not disclosed in her insurance application. The Kansas Insurance Department imposed sanctions on Golden Rule for unfair claim settlement practices, concluding that Golden Rule had wrongfully denied Denney coverage for a medically necessary procedure. The district court affirmed. The court of appeals reversed, concluding that McClary was not acting as Golden Rule’s soliciting agent when he submitted Denney’s health insurance application. The Supreme Court (1) reversed the court of appeals’ decision on the agency question, as substantial evidence supported the conclusion that McClary had the actual authority to solicit and submit applications directly to Golden Rule; and (2) reversed the Department and the district court on their ruling that Golden Rule violated Kan. Stat. Ann. 40-2404(9)(f) but affirmed the finding of a violation of subsection (d); and (3) affirmed the Department’s remedy. View "Golden Rule Ins. Co. v. Tomlinson" on Justia Law

Nationwide Mutual Insurance Company issued an automobile insurance policy, which included uninsured motorist coverage, to Melvin Briggs. After Nationwide sent Briggs a notice of nonrenewal of the policy, Briggs was involved in a collision with an uninsured motorist. Briggs's children filed a claim under the Nationwide policy for uninsured motorist benefits, which Nationwide denied. Nationwide subsequently sued Briggs’s children, seeking a declaratory judgment that it had nonrenewed Briggs’s policy before the automobile accident. The U.S. district court granted summary judgment for Nationwide, concluding that it had complied with statutory and policy requirements for notice of nonrenewal. On appeal, the Tenth Circuit Court of Appeals certified a question of law to the Kansas Supreme Court, which answered the certified question as follows: Notice to nonrenew an insurance policy that complies with the procedure set out in Kan. Stat. Ann. 40-3118(b) and a consistent provision in the policy itself is sufficient to force a lapse of coverage, regardless of whether a proper substantive basis for nonrenewal exists under Kan. Stat. Ann. 40-276a(a) and consistent policy language. View "Nationwide Mut. Ins. Co. v. Briggs" on Justia Law

While driving a vehicle owned by her employer (Employer), Appellant was injured in an accident caused by an underinsured motorist. Appellant claimed underinsured motorist (UIM) benefits under Employer’s commercial insurance package policy, which Appellant believed had been insured by Insurer, the same carrier that insured the tortfeasor. Insurer denied Appellant’s claim. A jury awarded Appellant damages, finding the tortfeasor at fault. The district court denied Insurer’s posttrial motion for judgment based upon its claim that it did not issue Employer’s insurance policy and granted Insurer’s motion for credit against the verdict in part, declining, however, to give Insurer credit for future medical expenses. The Supreme Court (1) affirmed the trial court’s denial of Insurer’s motion for judgment as a matter of law on Insurer’s claim that Appellant named the wrong insurance company as the defendant; (2) reversed the district court’s decision on Insurer’s motion for partial summary judgment on future medical expenses and vacated the jury’s award of future medical expenses; and (3) reversed the district court’s denial of Appellant’s motion for attorney fees. Remanded.
View "Bussman v. Safeco Ins. Co. of Am. " on Justia Law

After Employee was injured in a car accident with a police officer, Employer's workers compensation carrier (Claimant) sought to bring this tort action against City. Claimant gave notice to City that it was pursuing a negligence claim against it, claiming damages in the amount of $19,590. Claimant then brought a lawsuit in the district court, requesting $19,590 in damages. Several months later, Claimant sought leave to amend its petition to raise the amount of alleged damages to $228,088. City objected, arguing that Claimant's notice did not include "a statement of the amount of monetary damages that is being requested" as required under Kan. Stat. Ann. 12-105b(d)(5). The district court granted Claimant's petition, finding that Claimant's statutory notice substantially complied with 12-105b(d). A divided court of appeals affirmed the district court's ruling that the notice was in substantial compliance with the law. The Supreme Court affirmed, holding (1) under the circumstances, Claimant's notice substantially complied with 12-105b(d), as the notice contained all the information required by the statute; and (2) when a notice conforms with section 12-105b(d), subsequent amendments to the pleadings are subject to an inquiry into a claimant's bad faith or misleading conduct. View "Cont'l W. Ins. Co. v. Shultz" on Justia Law

Plaintiff filed a claim with his Insurer under his policy for stolen tools and equipment, which Insurer denied. Plaintiff sued. The district court granted summary judgment for Insurer. The court of appeals reversed and remanded for entry of judgment for Plaintiff. On remand, Plaintiff requested and received attorney fees related to both the district court and the appellate proceedings. The court of appeals reversed the award of appellate attorney fees, concluding Plaintiff had waived his right to appellate fees by not filing a motion for attorney fees with the court of appeals in the prior appeal. Petitioner filed a motion requesting appellate attorney fees for his second appeal in Snider II. The court of appeals awarded additional appellate attorney fees. Plaintiff appealed, requesting a judgment for the appellate attorney fees incurred in Snider I and an award of additional fees for the appeal in Snider II. The Supreme Court affirmed, holding that the court of appeals (1) correctly applied Supreme Court Rule 7.07(b), Evans v. Provident Life & Accident Ins. Co., and Kan. Stat. Ann. 40-908; and (2) did not err in determining the amount of reasonable attorney fees related this current appeal. View "Snider v. Am. Family Mut. Ins. Co." on Justia Law

The Workers Compensation Board awarded Plaintiff benefits under the Workers Compensation Act for an injury he sustained while operating a go-cart at an event sponsored by his employer (Employer). Employer and its insurance carrier (Insurer) appealed the award, claiming that Plaintiff's injuries were not compensable because they were sustained during a recreational or social event that Plaintiff was not required to attend. The court of appeals affirmed the Board. The Supreme Court reversed, holding that the Board applied the incorrect legal standard in determining whether Plaintiff's injuries arose out of and in the course of his employment, and the error was not harmless. Remanded to the Board to make the determination based on the statutory criteria of Kan. Stat. Ann. 44-508(f).
View "Douglas v. Ad Astra Info. Sys., LLC" on Justia Law